|Publication number||US7572254 B2|
|Application number||US 11/228,845|
|Publication date||Aug 11, 2009|
|Filing date||Sep 16, 2005|
|Priority date||Sep 17, 2004|
|Also published as||DE602005012853D1, EP1804704A2, EP1804704A4, EP1804704B1, EP1974684A2, EP1974684A3, US7846153, US20060167442, US20090198221, WO2006033989A2, WO2006033989A3|
|Publication number||11228845, 228845, US 7572254 B2, US 7572254B2, US-B2-7572254, US7572254 B2, US7572254B2|
|Inventors||Chris J. Hebert, Wade A. Bowe, Timothy J. Wood, Scott Tedder|
|Original Assignee||The Spectranetics Corporation|
|Export Citation||BiBTeX, EndNote, RefMan|
|Patent Citations (11), Referenced by (5), Classifications (9), Legal Events (8)|
|External Links: USPTO, USPTO Assignment, Espacenet|
This application claims the benefit of U.S. Provisional Application Ser. No. 60/611,191 filed Sep. 17, 2004, which is hereby incorporated by reference in its entirety.
The embodiments described herein are generally directed to improved apparatus and methods for the delivery of laser energy, including without limitation, to a laser delivery catheter.
Arteries are the primary blood vessels that are responsible for providing blood and oxygen to the heart muscle. Arterial disease occurs when arteries become narrowed or blocked by a buildup of plaque (as some examples, atherosclerotic plaque or other deposits). When the blockage is severe, the flow of blood and oxygen to the heart muscle is reduced, causing chest pain. Arterial blockage by clots formed in a human body may be relieved in a number of traditional ways. Drug therapy, including nitrates, beta-blockers, and peripheral vasodilatator drugs to dilate the arteries or thrombolytic drugs to dissolve the clot, can be effective. If drug treatment fails, angioplasty may be used to reform or remove the atherosclerotic plaque or other deposits in the artery.
Traditional balloon angioplasty is sometimes used to address the blockage by inserting a narrow, flexible tube having a balloon into an artery in the arm or leg. The blocked area in the artery can be stretched apart by passing the balloon to the desired treatment site and gently inflating it a certain degree. In the event drug therapy is ineffective or angioplasty is too risky (often introduction of a balloon in an occluded artery can cause portions of the atherosclerotic material to become dislodged which may cause a total blockage at a point downstream of the subject occlusion thereby requiring emergency procedures), the procedure known as excimer laser angioplasty may be indicated.
Excimer laser angioplasty procedure is similar in some respects to conventional coronary balloon angioplasty. A narrow, flexible tube, the laser catheter, is inserted into an artery in the arm or leg. The laser catheter contains one or more optical fibers, which can transmit laser energy. The laser catheter is then advanced inside the artery to the targeted obstruction at the desired treatment site. After the laser catheter has been positioned, the laser is energized to “remove” the obstruction.
In many procedures, the lesion is often engaged similar to conventional balloon angioplasty by crossing the blockage with a guidewire. The laser catheter's thin, flexible optical fibers facilitate the desired positioning and alignment of the catheter. Using the excimer laser, the clinician performs a controlled blockage removal by sending bursts of ultraviolet light through the catheter and against the blockage, a process called “ablation.” The catheter is then slowly advanced through the blockage reopening the artery. If there are multiple blockages, the catheter is advanced to the next blockage site and the above step is repeated. When the indicated blockages appear to be cleared, the catheter is withdrawn.
However, due to the configuration of the optical fibers in most prior art laser catheters, the clinician is able to ablate only material that is typically directly in front of the distal end of the catheter. Thus, the debulked tissue area is limited to an area approximately the size of the optical fiber area at the distal end of the catheter. Typically, follow-up angioplasty is recommended.
Thus, it would be desirable to provide an apparatus and methods that could bias the distal end of the laser catheter in a desired direction to enable the clinician to ablate an area larger than the area of the distal end of the catheter. Furthermore, because plaque may be eccentric in a blood vessel and require directional control to adequately ablate the target area, it would be advantageous to provide an apparatus that is sufficiently flexible to travel and rotate around the target area so that the clinician may control the area to be ablated.
In accordance with some embodiments, without limitation, the invention comprises a catheter having an elongated housing including a central axis between a first proximal end and a first distal end. The housing has a channel disposed between the first proximal end and the first distal end in communication with a cavity disposed proximate the first distal end. A laser delivery member is movable and at least partially disposed within the channel having a second proximal end and a second distal end. A ramp is disposed at an angle to the central axis and proximate the first distal end of the elongated housing within the cavity. The ramp is in communication with the channel and is adapted to move the second distal end of the laser delivery member outwardly from the central axis of the elongated member. A guidewire is in mechanical communication with both the laser delivery member and the elongated housing. The guidewire is adapted to bias the second distal end of the laser delivery member generally inwardly toward the central axis of the housing. In some embodiments, without limitation, the ramp is used to determine the offset of the central axis of the tip of the laser delivery member from the central axis of the housing, while keeping the axes substantially parallel, by adjusting the extent to which the laser delivery member travels on the ramp, and the disposition of the laser delivery member on the guidewire maintains the offset tip substantially parallel to the central axis of the housing. Methods of using same are also disclosed.
The features and inventive aspects of the present invention will become more apparent upon reading the following detailed description, claims, and drawings, of which the following is a brief description:
Referring now to the drawings, illustrative embodiments are shown in detail. Although the drawings represent some embodiments, the drawings are not necessarily to scale and certain features may be exaggerated to better illustrate and explain an innovative aspect of an embodiment. Further, the embodiments described herein are not intended to be exhaustive or otherwise limit or restrict the embodiments of the invention to the precise form and configuration shown in the drawings and disclosed in the following detailed description.
Referring now to
The guidewire 28 is threaded through a needle (not shown) into the artery and the needle is removed. The guidewire is advanced to or near the treatment site and may be inserted at its distal end into or across the lesion to be treated, as desired. The guidewire 28 serves as a tracking guide for the housing 12 and laser delivery member 22 to run on. Guidewires for such uses are known in the art and may comprise those with diameters between about 0.010 and 0.06 inches, with 0.014 and 0.018 inches diameter being typical sizes for artery applications. The guidewires may have bendable tips of coiled wire or plastic and a more rigid shaft of tapered ground stainless steel or other suitable material for push and torque transmission. The housing 12 and laser delivery member 22 are introduced coaxially, either sequentially or simultaneously, onto the guidewire 28 and advanced to a target area as further discussed below.
In some embodiments, without limitation, the housing 12 is introduced onto the guidewire 28 that has been inserted into the patient, and the housing is advanced to or near the treatment site such that portions of the guidewire 28 are disposed at least initially within the guide wire aperture 32, tapering end 30, and channel 26 of the housing. The laser delivery member 22 is then introduced onto the guidewire 28 so disposed within the catheter 10. The laser delivery member 22 is then advanced along the guidewire 28 such that the distal end 24 of the laser delivery member 22 becomes supported by the ramp 20 and oriented within the cavity 18 at any angle between 1 degree and 90 degrees in relation to the central axis of the housing 12, as desired by the user. Laser energy is then applied to the treatment site according to methods and protocols known to those of ordinary skill in the art. In some embodiments, without limiting the scope of the invention, in conjunction with the application of laser energy, the position of the laser delivery member 22 may optionally be varied by the user by moving the member 22 proximally or distally in order to adjust the angle of disposition of its distal end 24. Optionally, the offset of the central axis of the tip of the laser delivery member 22 from the central axis of the housing 12 may be varied by adjusting the distance that the delivery member 22 travels on the ramp 20 while keeping the central axis of the tip substantially parallel to the central axis of the housing 12. In addition, the catheter 10 containing the laser delivery member 22 may optionally be rotated along its central axis during the laser treatment and thereby apply laser energy to areas of the treatment site within the arc of the rotation. Optionally, the guidewire 28 may be withdrawn before application of laser energy and after the laser delivery member 22 has been introduced via the guidewire 28 into the channel 26 of the housing 12.
The elongated housing 12 is an elongated structure having a lumen or channel 26 large enough to accommodate the laser delivery member 22 and guidewire 28. The channel 26 extends the entire length of the housing 12 from the first proximal end 14 to the first distal end 16. Optionally, in some embodiments, the channel 26 may extend only to the ramp 20. Various control mechanisms including electrical, optical, and mechanical control mechanisms may be employed with the housing 12 permitting the catheter to be specifically directed to a target area (not shown) within the blood vessel. One embodiment of the housing includes a tapering end 30 and a guide wire aperture 32 capable of accepting the guidewire 28. The housing 12 may be made from any rigid, semi-flexible, or flexible material including a combination thereof made from a material including metal, plastic, rubber, and the like. Round or flat metal ribbon wire may be embedded within the material, inserted through the cavity 18, or disposed at the first distal end 16 to add stability to the housing 12 at the first distal end 16. The length of the housing 12 may be varied as desired. The housing 12 may be one piece or have a plurality of sections including a support structure section at the first distal end 16 as discussed further below. The distal end 16 of the housing 12 may include a non-traumatic polymer tip separate or integrated into the housing 12. This allows the forces seen in bending to be dissipated throughout the structure, reducing stress risers that could cause failure. The housing 12 may also include at least one wire disposed within the channel 26 to add robustness to the housing 12. The channel 26 is in communication with cavity 18 and wire aperture 32. The channel 26 is open to the exterior of the housing 12 through the cavity 18.
The ramp 20 is disposed within cavity 18 and is configured to project the laser delivery member 22 outwardly at various determinable angles. Optionally, the ramp 20 is used to determine the offset of the central axis of the tip of the laser delivery member 22 from the central axis of the housing 20, while keeping the axes substantially parallel, by adjusting the extent to which the laser delivery member 22 travels on the ramp 20. In some embodiments without limitation, the disposition of the laser delivery member 22 on the guidewire 28 maintains the offset tip substantially parallel to the central axis of the housing 12. In some embodiments, without limitation, the angle of lateral deviation of the ramp 20 from central axis of the housing 12 will vary in range as desired from one (1) degree to ninety (90) degrees, more usually in the range from thirty (30) degrees to sixty-five (65) degrees. By employing ramp 20 having different exit angles from the associated channel 26, different angles and/or offsets may be selected for treating a target area after the catheter 10 has been located within a patient. In some embodiments, without limitation, the ramp 20 may be adjustable, as one example only, by inflation of a balloon, and/or the ramp 20 may be slidable to allow varying degrees of offset.
The ramp 20 may be a built-up feature within the channel 26 of the housing 12 and may be located anywhere along the longitudinal length of the housing 12, but preferably at or within about 3 cm from the first distal end 16 of the housing 12. The ramp 20 may be formed or fused to the internal wall of the housing 12 and made from metal, plastic, rubber, and the like. In one embodiment, the ramp length (RL) is generally 1 cm. However, the ramp length (RL) may also be varied.
The first distal end 16 of the housing 12 may be formed from plastic, metal, or any combination thereof. When metal is used, materials must be selected to provide appropriate flexibility without producing failure since the cavity 18 tends to reduce the structural integrity of some portions of the housing 12. Thus, in some embodiments, the first distal end 16 comprises a shape memory alloy, as one example only, nickel-titanium alloy. In other embodiments, without limitation, the first distal end 16 may comprise a stent-like structure proximal, distal, within, or a combination of such proximate the cavity 18. The stent-like structure may be made from at least one of stainless steel, cobalt-chromium, nickel titanium, and the like.
An alternative embodiment of the housing 12 comprises having at least one section at the first distal end 16. A first embodiment of a support structure is support member 34 as shown in
In operation, once the guidewire 28 is in place, or as it is being positioned, the housing 12 is inserted. This housing 12 has a central channel 26, which may include the laser delivery member 22 and guidewire 28. The housing 12 and the laser delivery member 22 are advanced through the guidewire into the desired target area. Therefore, the guidewire 28 is in mechanical communication with both the laser delivery member 22 and the elongated housing 12. However, the housing 12 may be advanced prior to inserting the laser delivery member 22. As the laser delivery member 22 approaches the ramp 20, it is biased in an outwardly direction through the cavity 18. The further the laser delivery member 22 is advanced, the more it projects outwardly from the cavity 18 at the first distal end 16 of the housing 12. In some embodiments, without limitation, the guidewire 28 disposed within the laser delivery member 22 biases the second distal end 24 of the laser delivery member 22 inwardly providing a travel path and forcing the second distal end 24 to face forward along the guidewire 28 and generally parallel to the centerline of the housing 12. Otherwise, the second distal end 24 of the laser delivery member 22 would continue along the ramp 20 further projecting away from the centerline of the housing 12 and would not be “attacking” the target area in front of the catheter 10 as desired.
The preceding description has been presented only to illustrate and describe exemplary embodiments of the methods and systems of the present invention. It is not intended to be exhaustive or to limit the invention to any precise form disclosed. It will be understood by those skilled in the art that various changes may be made and equivalents may be substituted for elements thereof without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from the essential scope. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed as the best mode contemplated for carrying out this invention, but that the invention will include all embodiments falling within the scope of the claims. The invention may be practiced otherwise than is specifically explained and illustrated without departing from its spirit or scope.
|Cited Patent||Filing date||Publication date||Applicant||Title|
|US5026366 *||Dec 2, 1986||Jun 25, 1991||Cardiovascular Laser Systems, Inc.||Angioplasty catheter and method of use thereof|
|US5318032 *||Feb 5, 1992||Jun 7, 1994||Devices For Vascular Intervention||Guiding catheter having soft tip|
|US5425355||Jan 28, 1991||Jun 20, 1995||Laserscope||Energy discharging surgical probe and surgical process having distal energy application without concomitant proximal movement|
|US5755714 *||Sep 17, 1996||May 26, 1998||Eclipse Surgical Technologies, Inc.||Shaped catheter for transmyocardial revascularization|
|US5792118 *||Dec 12, 1996||Aug 11, 1998||Kurth; Paul A.||Permanent catheter with an exterior balloon valve and method of using the same|
|US5891133 *||Mar 29, 1996||Apr 6, 1999||Eclipse Surgical Technologies, Inc.||Apparatus for laser-assisted intra-coronary transmyocardial revascularization and other applications|
|US6022342 *||Jun 2, 1998||Feb 8, 2000||Mukherjee; Dipankar||Catheter introducer for antegrade and retrograde medical procedures|
|US6056743 *||Mar 5, 1998||May 2, 2000||Scimed Life Systems, Inc.||Percutaneous myocardial revascularization device and method|
|US20020103459 *||Dec 5, 2001||Aug 1, 2002||Sparks Kurt D.||Catheter system for vascular re-entry from a sub-intimal space|
|US20050149176 *||Dec 29, 2003||Jul 7, 2005||Scimed Life Systems, Inc.||Selectively light curable support members for medical devices|
|US20060094930 *||Dec 13, 2005||May 4, 2006||Sparks Kurt D||Catheter system for vascular re-entry from a sub-intimal space|
|Citing Patent||Filing date||Publication date||Applicant||Title|
|US7846153||Mar 18, 2009||Dec 7, 2010||The Spectranetics Corporation||Apparatus and methods for directional delivery of laser energy|
|US8628519||Dec 17, 2008||Jan 14, 2014||The Spectranetics Corporation||Rapid exchange bias laser catheter design|
|US9308047||Dec 20, 2013||Apr 12, 2016||The Spectranetics Corporation||Rapid exchange bias laser catheter design|
|US9320530||Mar 13, 2013||Apr 26, 2016||The Spectranetics Corporation||Assisted cutting balloon|
|US20090198221 *||Mar 18, 2009||Aug 6, 2009||The Spectranetics Corporation||Apparatus and methods for directional delivery of laser energy|
|U.S. Classification||606/15, 606/14, 606/13|
|Cooperative Classification||A61B2017/22061, A61B2018/2238, A61B2017/22038, A61B18/24|
|Apr 26, 2006||AS||Assignment|
Owner name: SPECTRANETICS CORPORATION, THE, COLORADO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:HEBERT, CHRIS J.;BOWE, WADE A.;WOOD, TIMOTHY J.;REEL/FRAME:017541/0965;SIGNING DATES FROM 20050926 TO 20051207
|Sep 7, 2010||CC||Certificate of correction|
|Apr 8, 2011||AS||Assignment|
Owner name: WELLS FARGO BANK, NATIONAL ASSOCIATION, COLORADO
Free format text: SECURITY AGREEMENT;ASSIGNOR:THE SPECTRANETICS CORPORATION;REEL/FRAME:026100/0647
Effective date: 20110225
|May 24, 2011||AS||Assignment|
Owner name: THE SPECTRANETICS CORPORATION, COLORADO
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TEDDER, SCOTT;REEL/FRAME:026335/0822
Effective date: 20040907
|Jan 30, 2013||FPAY||Fee payment|
Year of fee payment: 4
|Dec 10, 2015||AS||Assignment|
Owner name: THE SPECTRANETICS CORPORATION, COLORADO
Free format text: RELEASE BY SECURED PARTY;ASSIGNOR:WELLS FARGO BANK, NATIONAL ASSOCIATION;REEL/FRAME:037261/0819
Effective date: 20151208
|Dec 11, 2015||AS||Assignment|
Owner name: MIDCAP FINANCIAL TRUST, AS AGENT, MARYLAND
Free format text: SECURITY INTEREST (TERM);ASSIGNOR:THE SPECTRANETICS CORPORATION;REEL/FRAME:037269/0506
Effective date: 20151207
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Effective date: 20151207
|Feb 9, 2017||FPAY||Fee payment|
Year of fee payment: 8